Symptomatic fibroids in a perimenopausal woman with previous two caesarean sections and incisional hernia repair. Can surgery be avoided?

Leiomyomas are the most common benign gynaecological tumour and contribute to 40-60% of hysterectomies performed all over the world. Despite proven benefits of GnRH analogues in reducing the size of myoma, it is used mostly as a temporary preoperative drug, as it has not shown to be associated with complete mass regression. We present a case of an abnormal uterine bleeding in a perimenopausal woman with history of multiple caesarean sections and incisional hernia repair. The patient was diagnosed with leiomyoma and was severely symptomatic due to anaemia. She responded to GnRH analogues and the mass regressed completely after 6 months. A favourable outcome in this patient establishes the role of medical treatment in symptomatic uterine fibroids in perimenopausal woman with previous abdominal surgeries where the risks of surgical intervention may be higher.